Learn About It Before Surgery
“Learning about your recovery can tell you a lot about a surgeon and the quality of your surgery. A more skilled surgeon usually offers you a simpler and faster recovery.”
Learn about recovery before surgery? You must be kidding! Why not just worry about that when the time comes? Because...
Learning about recovery can potentially tell you more about a surgeon’s skills than anything else you can ask a surgeon. It is almost impossible for any surgeon to exaggerate the surgeon’s level of expertise if you ask the right questions about recovery.
Your experiences during recovery are a direct consequence of what happens during your surgery.
The less traumatic your surgical procedure, the easier and faster your recovery.
You can’t see what your surgeon will do in the operating room, but you can quickly figure out how much trauma and bleeding you’re likely to experience by simply asking in detail about recovery.
Would you like to have an easier and faster recovery? Would you prefer less time away from your normal activities? Less time off work? Less bruising? No drain tubes coming out of your body? No tight bandages or special bras? All of these things are possible, but only if you choose the right surgeon. In fact, all of these are routine in some augmentation practices. But not in all augmentation practices. The only way you’ll know is to ask about recovery before your augmentation!
What’s to Recover From?
Any operation causes some degree of injury (trauma) to your tissues. The more precise and delicate the surgery, the less trauma, but some tissue trauma is unavoidable. Your body responds to tissue trauma in predictable ways: pain, swelling, bruising, and stiffness after surgery.
The greater the amount of trauma to your tissues, the more discomfort and other symptoms you’ll have after surgery.
The greater the trauma, the longer it takes your body to heal and the longer it takes for you to feel normal and return to normal activities.
The more trauma and bleeding you experience during surgery, the greater the likelihood you may develop problems such as capsular contracture or hematoma that require additional operations and can compromise the quality of your result.
To put an implant in your breast, the surgeon creates a pocket to receive the implant. The pocket can be behind breast tissue (retromammary), or behind breast tissue and behind muscle (partial retropectoral). If it’s just behind breast tissue, the surgeon lifts the breast tissue off the pectoralis muscle to create the pocket. If you are thin and need more soft-tissue coverage, you need additional muscle cover over the implant, and the surgeon needs to create a pocket behind the muscle (submuscular) or partially behind muscle and partially behind breast tissue (dual plane). Traditionally, you could expect more discomfort, swelling, and a longer recovery. How much longer? It depends on your tissues, and it depends on how the pocket is created at surgery. Since we developed and published the first techniques in the history of augmentation that allow patients to return to full normal activities within twenty-four hours, you can now recover just as rapidly if an implant is placed behind muscle as if it were placed only behind breast tissue! Using our twenty-four-hour recovery surgical techniques, manipulating your pectoralis muscle to provide more coverage, if done properly, does not result in more pain or a longer recovery.1,2
Recovering from a pocket created behind breast tissue is NOW THE SAME AS RECOVERING FROM A POCKET CREATED BEHIND MUSCLE, USING OUR TWENTY-FOUR-HOUR RECOVERY SURGICAL TECHNIQUES!1,2 Why? We have now developed techniques that minimize trauma and bleeding when we manipulate your pectoralis muscle.
If you are thin and need muscle cover (or need it for other reasons), it is more important to have muscle cover than to avoid slightly more tissue trauma. You and your surgeon must decide based on your tissues. even if a surgeon is unfamiliar with our twenty-four-hour recovery surgical techniques, you should prioritize assuring adequate soft-tissue cover over your implant.3,4
The more tissue trauma caused by your surgery, the longer and more difficult your recovery. Our published studies and techniques in the past few years1,2,3,4,5,6 have completely redefined patient recovery, and it all results from techniques that minimize trauma to your tissues and minimize bleeding.
Ask about recovery and compare what surgeons tell you. the opportunity to return to full, normal activities within twenty-four hours following your augmentation tells you that a surgeon really can deliver less trauma and bleeding, not just say that he or she can. Longer recovery times usually imply more tissue trauma at surgery. No matter what a surgeon tells you about the surgeon’s expertise or techniques, recovery tells the truest story.
Tissue Stretch—Another Form of Tissue Trauma
Your implant will stretch your tissues and also stretch nerves in and around your breast. The larger the implant or the tighter your tissues, the more pressure the implant exerts on your tissues. This pressure subsides over time (weeks to months) as your tissues stretch to accommodate your implant. But pressure of an implant (especially a larger implant in tighter tissues) can produce more discomfort, more stretch on nerves in the breast, and more temporary or permanent loss of sensation. The message? Some tissue stretch injury is unavoidable, but
Excessively large implants in excessively tight tissues can produce excessive stretch trauma that can cause more discomfort and temporary or permanent sensory loss.
Consider your tissues when selecting implant size.
Tissue stretch can produce temporary numbness, tingling, pin-prick sensations, and other weird feelings during the first few weeks of recovery. These sensations are a normal part of recovery. Sensation varies tremendously from patient to patient and is not predictable. If you select a large implant that stresses your tissues excessively, expect more sensory loss and a longer time for sensation to return to near normal.
Bruising and Swelling—What Causes It?
Bruising is blood within your tissues.
Bruising and swelling are caused by tissue trauma.
The more tissue trauma, the more bruising and swelling.
The more bruising and swelling, the longer your recovery.
The more bruising and swelling, the longer before you’ll return to normal activities.
You can judge a lot about your upcoming surgery by asking:
Will I have bruising? For how long? What about swelling? When can I return to normal activities? Will I have drain tubes? Will I have any type of bandage or bra to compress my breasts?
tissuE trAumA And surgicAl tEchniquE
In chapter 6, you learned about different surgical techniques, different methods that surgeons use to create the pockets for your implants. The technique a surgeon uses to create the pocket can significantly affect how much tissue injury occurs and, hence, can significantly affect your recovery.
Blunt dissection techniques cause substantially more trauma compared to specially developed electrocautery dissection techniques.
Sharp dissection techniques cause substantially more bleeding compared to specially developed electrocautery techniques.
Ask your surgeon specifically what technique will be used to create the pockets for your implants. If it’s not twenty-four-hour1 precise electrocautery dissection techniques and instruments, expect more bruising, swelling, and a longer recovery time.
Tubes Coming out of Your Body
No matter how tiny a tube, when you see it coming out through a puncture in your skin, it looks the size of a fire hose. You won’t like it. You’ll be told that it’s necessary to remove fluid from around your implant and that if you don’t have it, your chances of collecting blood (hematoma), fluid (seroma), and chances of capsular contracture are increased. True? Not necessarily. Using techniques we developed and published1,2,4,6 in over 1,600 reported cases, hematomas occurred in only 0.09 percent and seromas in 0.06 percent. Optimal instrumentation and precise surgical techniques unquestionably make a difference.
All electrocautery dissection instruments and techniques are not the same and do not necessarily deliver the same results. A surgeon may tell you that he or she uses electrocautery dissection, but the real question is not whether the surgeon uses electrocautery dissection, but precisely how the surgeon uses it and whether the surgeon has the optimal instruments. The best way for any patient to judge is to simply ask about recovery! If a surgeon has optimal instrumentation and knows optimal techniques, the surgeon can offer you twenty-four-hour return to normal activities.
It is true that if substantial bleeding and tissue injury occur at the time of surgery, your body will release more blood and fluid into the pocket around the implant and that it’s better to remove the fluid with a drain than to leave it there. But it’s also true that:
Ask if you’ll need drains. If the answer is yes, does that mean that the surgeon isn’t good or isn’t doing a good job? Not necessarily, but it should raise the question “Why do I need those?” Does it mean that the surgeon is doing something wrong? No. You should consider many factors in choosing a surgeon, but this is certainly one of those factors. Why does the surgeon need drains when other surgeons don’t? Why does a surgeon need drains when there are peer-reviewed, scientific publications in the most respected journal in plastic surgery describing techniques that make drains obsolete in first-time breast augmentations? Get answers from different surgeons, and then you decide.
Anesthesia and Recovery Time
It’s nice to have anesthesia when you’re having surgery! Having anesthesia means that you will receive drugs. The longer the operation, the longer the anesthesia, and the more drugs you’ll receive. When the drugs are discontinued following surgery, your body must break down (metabolize) the drugs before you will feel normal. Anesthetic drugs often cause some hangover. Hangover can be good if it eases your discomfort immediately after surgery. But once you’re feeling better, a hangover that lasts longer is a nuisance because you don’t feel normal as quickly.
Some people are prone to develop nausea following anesthesia. Even the best antinausea drugs don’t totally prevent nausea in some patients. However, the fewer narcotic drugs you get, the less chance of your developing nausea. The shorter the anesthesia and the less tissue trauma during surgery, the fewer narcotic drugs you’ll need.
The longer you need anesthesia and the more tissue trauma, the more drugs you’ll need, the longer you’ll be required to remain at the surgery facility, and the longer time before you’ll feel normal.
Ask about surgery time, anesthesia time, time in the recovery room, and how long until you’ll return home the day of surgery. all of these factors will tell you a lot about how much anesthesia you’ll receive and when you can expect to feel normal.
There is no avoiding the fact that the shorter your surgery and the less tissue trauma, the fewer drugs you’ll need, the less chance of nausea and hangover, and the more rapidly you’ll return to normal.
I know I’m repeating, but I want to be sure you’ve got the picture!
In our peer-reviewed and published study of 627 patients in our twenty-four-hour recovery publications,1,2 refining our anesthetic and surgical techniques resulted in documented recovery times that we previously considered impossible. All patients were operated on using general, endotracheal anesthesia, and here are the recovery results:
Time from the beginning of the augmentation procedure until patients left our accredited outpatient surgery facility to return home averaged less than ninety minutes! All patients scored maximum on recovery criteria, and all were able to raise their arms fully over their heads before leaving.
No patient required narcotic-strength pain medications at home.
An incredible 96 percent of the patients were able to resume full, normal activities within twenty-four hours!
Full, normal activities were defined as the patient’s being able to do the following:
- Raise arms above the head with arms fully extended, three times every four hours
- Lie directly on the breasts
- Lift all normal weight objects
- Perform all normal activities
- Drive a personal car
- Go out for work, shopping, or entertainment
Specific instrumentation and techniques unquestionably minimize surgical trauma and bleeding and allow this type of recovery.
General Anesthesia Versus Local Anesthesia With Sedation— What’s Best?
When considering anesthesia, what’s best is what is safest and allows your surgeon the greatest degree of control during your operation.
Many people don’t love the idea of being “put to sleep.” It just has a bad ring to it. Everyone has heard about disasters that have occurred with anesthesia. All the disasters are reported, but you never hear about the hundreds of thousands of anesthetics daily that go without a hitch. So it’s normal to think: “The less anesthesia the better. If I can have this surgery without being ‘put to sleep,’ that’s better, right?” Wrong!
When problems occur with anesthesia, most fall into two general categories:
You have a totally unpredictable reaction to a routine anesthetic drug (an idiosyncratic drug reaction).
You regurgitate while you are asleep or heavily sedated, and instead of vomiting the material out of your mouth, you suck stomach acid down your windpipe into your lungs. Your lungs react violently, and reflexes usually cause your heart to react by developing abnormal heart rhythms—a very bad combination.
Both of these potentially dangerous events are exceedingly rare, but they can occur. The first, an idiosyncratic drug reaction, cannot be predicted or totally prevented. If it occurs, it’s treatable. The second event (aspiration), however, is almost totally preventable by inserting a small tube with a balloon into your windpipe after you’re asleep. When the balloon is inflated, it minimizes risk of stomach contents passing into the windpipe. The only trade-off is that your throat may be a little raspy from the tube for a few hours after surgery.
Endotracheal tubes can be lifesaving, but you won’t enjoy having an endotracheal tube (the tube with a balloon in your windpipe) unless you’re asleep. If you have local anesthesia, you are not asleep. More drugs combined with the local anesthesia will heavily sedate you, but technically you’re still not asleep. Mainly, you’re not asleep enough to tolerate an endotracheal tube. If you have local anesthesia injected, it deadens the tissues, but you’ll need additional drugs to stay comfortable. If you get uncomfortable during surgery, your surgeon may need to stop while the person giving your anesthesia gives you more drugs. That slows things down. Remember, longer anesthesia, more drugs and more nausea result in a longer recovery. Does local anesthesia work? Usually, but those additional drugs that keep you comfortable can also interfere with your gag reflexes. If you regurgitate, you may be too sedated to gag and vomit, and the stomach acid can go down your windpipe because you don’t have an endotracheal tube in place.
Local anesthesia with sedation (you’re not asleep) usually does not allow you to have an endotracheal tube to protect you from aspiration.
There is no peer-reviewed scientific publication on a series of breast augmentation patients using local anesthesia that is even remotely comparable to the recovery results in our twenty-four-hour studies.1,2 Local anesthesia simply doesn’t measure up any more and is no longer state-of-the-art for breast augmentation.
General anesthesia (you are asleep) with an endotracheal tube in place better protects you against aspiration.
Optimal general anesthsia is unquestionably more predictable at keeping you asleep and comfortable, so you are less likely to remember events of your surgery, and your surgeon has more control over a larger number of factors that affect your outcome.
Some surgery facilities are not equipped and accredited to administer general anesthesia. You certainly don’t want to have any anesthesia unless a facility is fully accredited and its personnel are equipped and optimally trained. Before surgery, ask your surgeon the following:
What type of anesthesia will I have?
Which is safer, local or general?
Which offers better control, local or general? Under local anesthesia with sedation, how am I protected against aspiration?
Can you offer me both options and let me choose?
Popular Misconceptions about Anesthesia and the Facts
A popular misconception that general anesthesia causes more nausea than local anesthesia is not necessarily true. Nausea relates more to the type and quantity of drugs you’re given and how they are given. Some medical personnel administer anesthesia better than others. Ask your surgeon who will be giving the anesthesia. Is this someone the surgeon works with regularly? How regularly?
A second misconception is that general anesthesia requires giving you more drugs than local anesthesia. Again, not necessarily true, and our published studies and results now prove this fact beyond question.1 By having you asleep and your surgeon having optimal control, your surgery can proceed more smoothly in a shorter time. General anesthesia can require fewer drugs because of more control and a shorter surgery time. Again, it depends on who is doing it and how they do it.
A third misconception is that it takes longer to recover from general anesthesia. Again, not true, as our peer-reviewed and published data prove.1 Recovery depends on the amount of drugs you received during and after surgery. The longer the operation, the more drugs you’ll receive. Well-done general anesthesia involves a shorter recovery than many local-anesthesia-with-sedation cases. If a surgeon does not have access to top-notch general anesthesia, local with sedation can be a better option.
You have a choice of surgeons and a choice of surgical facilities. No surgeon or facility can offer you risk-free anesthesia. It doesn’t exist. But one of the major risks (aspiration) is almost totally preventable with general anesthesia. It’s up to you to ask the right questions and make the best team decisions.
Bandages, binders, and special bras
Another aspect of recovery that can tell you a lot about your surgery is the use of special bandages, binders, and special bras.
Devices don’t produce optimal results. Optimal surgery produces optimal results.
Key questions about any device you have to tolerate following augmentation are “Why is the device necessary in the first place?” and “If techniques to avoid all of these devices are now published in the most respected journal in plastic surgery,1,2,3,4,5,6 why do many surgeons continue to use all of the postoperative devices?”
The more you rely on external devices to produce a result, the less predictable the result.
The biggest problem with devices is that you have to use and tolerate them.
How much do you like wearing things that are tight, uncomfortable, or a nuisance?
What do you often do with things you don’t enjoy wearing? take them off!
So when a surgeon depends on a device that you can wear or not wear, the result is not as predictable.
Does that mean that all external devices are a bad idea? Not necessarily. If a surgeon feels that a device is necessary after surgery, the surgeon should have a reason. You should ask for the reason and ask if there are published techniques to avoid all of those devices.
Survey several surgeons, and you’ll find that bandages vary from none to mummy-like, near-total body wraps. Why? Often because a surgeon was trained to use a certain type of bandage for augmentation and has used it ever since. During my residency training, I was taught that it was necessary to firmly wrap every augmentation patient with an elastic bandage that covered everything from the neck to the waist. The reason given was that the elastic wrap would put pressure on the breasts to reduce risks of bleeding and provide support to keep the patient comfortable. Sounded logical to me, so I did it. What they didn’t know and didn’t tell me was that with optimal instruments and techniques, bleeding requiring the wraps didn’t occur, and compression was really unnecessary. Patients tolerated the compression wraps and garments for a couple of days because they thought it was necessary. But when I asked them how it felt, they all said, “Horrible. It’s tight, it rolls up, it is hot, it itches, and I can’t take a bath and wash my hair!” My patients have taught me that they would much rather be able to bathe and wash their hair and avoid the nuisance and expense of additional wraps or compression garments if they were really unnecessary.
Bandages to stop bleeding? Why not just do the surgery in a way that you don’t have bleeding in the first place? How you do the operation is what determines the amount of bleeding. Not a bandage, not a wrap, not anything else. So by improving how we perform the operation, we’ve done away with bandages completely. No bandages on any patient for the past fifteen years! Any bleeding? Hematoma in less than one-tenth of one percent of patients.1,2,4,6 Bleeding can occur after surgery—no matter what technique is used. But . . .
Bandages don’t prevent bleeding as well as optimal
instrumentation and precise surgical techniques do.
Bandages are a nuisance that prevent you from
showering and washing your hair.
Bandages are largely unnecessary, provided certain
surgical techniques are used.
Bandages to improve patient comfort? Ever been wrapped in an elastic bandage for a couple of days? Ever had adhesive tape pulled off? Ever been unable to bathe or wash your hair for a day or two? In some operations, bandages are necessary. Following augmentation, they are not necessary, provided specific surgical techniques are used.
Binder Devices, Straps
Quite an array of binder devices exists, mostly touted as essential aids to keep an implant in place or to push it somewhere: upward, downward, inward, outward. Surgeons utilize these devices in a variety of ways for a variety of reasons, usually due to a bad experience with implants “going” somewhere that neither the surgeon nor the patient likes.
Implants largely “go” where surgeons place the implants at surgery. If the pocket to receive the implant is substantially larger than the implant, the implant can move. When implants are put under the muscle, you’ll hear from some surgeons and patients that the implants tend to ride up. Behold, an opportunity for a device, some type of strap or binder across the upper breast to hold them down.
The tendency of implants to ride up is usually due to one of four causes:
- Excessive tissue forces are pushing on the lower implant,
- The implant was positioned too high at surgery,
- The implant chosen was too large for the patient’s tissues, or
- The distance between the nipple and fold beneath the breast was set inappropriately relative to the width of implant placed in the breast.
The most common reason for excessive tissue pressure on the lower implant is that the implant is too large for the patient’s tissues. When too much implant is placed into too tight a pocket, the pocket pushes back, especially in the lower breast, and the implant is pushed upward. Under muscle, the pocket tends to be even tighter, especially if specific techniques aren’t used to release pressure of the lower muscle on the implant. If you’re thinking about a larger implant and have tight tissues, a binder or strap may make some sense, but . . .
Specific surgical techniques— accurate, precise pocket
development and control—are more effective than
binder devices at controlling implant position.
When you and your surgeon select an implant that is
excessively large for your tissue characteristics, the risk
of implant displacement increases.
How long are you willing to wear a binder device? What happens when you take it off? An excessively large implant exerts excessive pressure forever. Want to wear a binder device forever?
If the implant is in a good position for the first few weeks and then displaces upward, wound healing mechanisms beyond any surgeon’s control may be the cause.
Some women love them; other women hate them! Some need them; some don’t. If you ask women about bras following their augmentation, I promise you’ll hear answers all over the map. Some will say you absolutely must wear a bra, even a certain type. Others will say no; it’s not necessary. Surgical garment companies love bras and support garments because they boost the bottom line. But every different manufacturer will tell you that its design is better for several reasons. How many bras do you need? It depends on whom you ask. The companies will tell you several. You’ll probably enjoy at least two, so you can wash one while using the other. The real bottom line?
If a bra or a certain type of bra were best, everyone would be using it. It just isn’t so.
If special bras were really necessary at all, patients wouldn’t do well without them. and believe me, a lot of patients do great without them every day!
If you or your surgeon feel that you need them or like them, use them. Just don’t fool yourself into thinking they’re really necessary from a medical standpoint, provided you make optimal decisions and apply certain surgical techniques.
Some surgeons feel that a bra holds the implant in place. My question is why do you need to hold the implant in place? If the pocket is created accurately in the right location, the pocket holds the implant in place. Other surgeons feel that the pressure of a bra decreases chances of bleeding and makes patients more comfortable. I can’t envision depending on a bra to prevent bleeding. Surgical techniques prevent bleeding. And comfort? Just ask several women, and you’ll get several answers. Some are more comfortable with a bra, and some without. It’s a personal preference.
What do we tell our patients? “You’ll go home with a single piece of tape over your incision. In the first few weeks after surgery, you can wear or not wear a bra. It’s your choice. Wearing or not wearing a bra won’t affect your final result at all. If you’re more comfortable wearing a bra, or if you want to create a certain look, go for it, the sooner, the better. It’s not necessary to worry about a bra harming your incision, even if it’s an underwire bra and your incision is under your breast. On the other hand, if you’re more comfortable not wearing a bra, don’t wear one. You don’t need it, especially in the first few weeks after surgery.”
You need a bra, however, when you are engaging in any activity that causes your breasts to bounce, such as running, jogging, aerobics (even low-impact aerobics), horseback riding, etc. Why? Gravity alone, even with a bra, pulls breasts downward. Add the force of bouncing, and the migration will definitely start sooner. No way around it. If they’re bouncing, they’re sagging sooner and more! What type of bra will prevent this? Any tight bra that prevents bouncing. Sometimes two jog bras, one size too small. Whatever it takes, stop the bouncing! This rule applies from now on if you want to minimize tissue stretch and potential sagging.
Recovery Times and Limitations
What is normal for recovery times? Which limitations are mandatory, and which are optional? Do all patients respond the same? What is a normal time to return to normal activities? To athletic activities? What does all this tell you about your upcoming surgery?
The shorter and easier a surgeon describes your recovery time, the less trauma that surgeon is causing to your tissues.
All patients don’t respond the same after surgery. Some have a higher tolerance for discomfort than others. Some don’t have any tolerance at all—for any discomfort. Some follow instructions better than others. Some remember what they’ve learned better than others. Most are impatient for things to get back to normal regardless of how many times they’ve been told that tissue-healing takes time.
If you have a very low tolerance for discomfort, you will have a more difficult recovery. You’re likely to request more pain medications and use them more frequently and longer. Pain medications make you sleepy while they make you comfortable; you won’t get moving as well, and you may become constipated. It’s always easier to take pain medications than to work through discomfort, but it’s definitely not better. Optimal surgery lets you avoid strong, narcotic pain medicines, and most of all, makes your recovery a lot shorter and easier.
Pain medications are a very mixed blessing—the less the better, and the sooner you’re off them, the better.
But despite patient variations, you can bank on the following:
The more you know what to expect, the easier your recovery.
The less trauma and bleeding during surgery, the faster and easier your recovery.
The better you follow instructions, the easier and less complicated your recovery.
The higher your discomfort tolerance, the more rapid
The more rapidly you resume normal activities, the
shorter your recovery.
For the sake of discussion, let’s define normal activities as
- Lifting your arms above your head,
- Lifting normal weight objects,
- Driving your car,
- Carrying out all normal (non-athletic) daily activities, and
- Lying directly on your breasts.
Before your surgery, specifically ask when you can begin each of these activities. From the answers, you’ll learn a lot about your upcoming surgery.
If you can’t return to these normal activities within two weeks, something’s not ideal. tissue injury, low pain tolerance, too many pain medications, a complication— something!
If you can return to all normal activities in less than one week, you’ve probably made good choices of surgeon and techniques.
If you can return to all normal activities in less than four days, you and your surgeon are both doing well, but there’s still room for improvement!
If you’re able to return to normal activities within forty-eight hours or less, you and your surgeon are dynamite, and you just had a state-of-the-art surgical procedure! Over 96 percent of our patients return to full, normal activities within twenty-four hours following their augmentations, even when placing the implant submuscular.1,2
If you’re told that expecting to return to normal activities in less than four days is unreasonable and just won’t happen, you might want to continue your surgeon search.
One of Our Typical Patients Describes Her Recovery...
The following letter was written by one of our patients to thank someone for providing information about us. It is reprinted with the patient’s permission.
Here is a brief synopsis of my BA experience with Dr. Tebbetts. He was Fantastic. I flew in from the Midwest and arrived on a Thursday. I had my consultation with him that Thursday afternoon. I stayed with a friend of mine in Dallas, so we went out that evening, had dinner, and went home. The next morning, I went in at 7:45 for surgery. Even the waiting experience was pleasant. I waited in a comfortable recliner while I was being prepped for my surgery. I remember waking up immediately after surgery, and Dr. Tebbetts asked me to see if I could raise my arms above my head. I did it with no problem. That afternoon I went to the place where I was staying, with my friend, and I rested most of the day. However, I could change my own clothes (over my head) and do many other things with no problem. I took my prescribed medication that evening only. The next day (24 hours post-op) I took Advil and never took anything else beyond that. I showered, blow-dried my hair, went shopping, got dressed, all at 24 hours post-op. I remember that evening, I made myself a sandwich and had no problem reaching the bread, which was in a cabinet well above my head. When I flew home (48 hours post-op), my children were not feeling well, and I was able to squat down and pick up my 20-lb son with no problem. I’m now 4 days post-op and I have been sleeping on my side for the last two evenings. I must say that if I had to repeat this experience, I wouldn’t change a thing. Dr. Tebbetts and his staff were very helpful and professional. I am extremely pleased with my choice. As for the look, the partial-submuscular, anatomical implants I received look great now, but I think that they will look even better when they drop in a few months. That’s about it. Let me know if I can answer any other questions for you. Thanks again for helping me find Dr. Tebbetts!
(Names are fictitious to protect patient privacy.)
This letter describes a typical experience for the vast majority of our patients. Because there is a normal variation in patients’ tolerance to discomfort and their ability to follow our postoperative instructions, we can’t guarantee this experience for every patient. But our commitment to patient education and the surgical techniques that we use in every case offer this type of experience to every augmentation patient.
Athletic Activities and Emotional Stress
Athletic activities and emotional stress increase your pulse rate. When your pulse rate rises, your blood pressure rises. A rise in blood pressure can cause internal bleeding in your breasts. Internal bleeding means another operation, tubes coming out of your body for a while, and a higher risk of capsular contracture. It just isn’t worth it!
Athletic activities include any activity that causes your pulse rate to increase significantly (more than 20 percent above your resting pulse rate): running, fast walking, bicycling, aerobics of any kind, heavy or prolonged exercise of any sort.
Emotional stresses vary a lot, but the most likely involve personal relationships or severe job stresses. Believe it or not, these stresses can cause just as much pulse and blood pressure increase as athletic activities. Again, it’s not worth it! Avoid emotional stress as much as possible.
Avoid athletic activities of any sort and severe emotional stress for at least two weeks following surgery.
You should be able to start a gradual return to normal exercise activities beginning two weeks after surgery. If it hurts, stop it and try again two days later. Your body is smarter than you. Listen to it!
If you aren’t allowed to begin returning to athletic activities in less than four weeks, ask questions. Why not? What’s going to happen? ask other surgeons!
Recovery Questions . . . and the Message from the Eanswers
Before your surgery, ask questions about your recovery:
What will my recovery be like?
Will I have bruising?
Will I have drain tubes coming out of my body?
When can I return to normal activities, drive my car, lift normal objects, raise my arms above my head, etc.?
When can I bathe?
Do I need special bandages, bras, or binders?
When can I return to athletic activities?
The better the answers to these questions, the better you’ll like your recovery and, likely, your result!
Ask Surgeons to Commit
If you get hedged answers to any of these questions from surgeons, persist. Ask the questions again. Ask for pinpoint answers. No surgeon can give absolute guarantees in any single case, but answers to these questions provide you with valuable information about what you can expect.
This subject isn’t nuclear physics. Part of recovery is you, and part is your surgeon. What your surgeon does in the operating room can substantially affect your recovery. You can’t see what the surgeon does in the operating room, but you can gain insight before surgery by asking about your recovery. Either way, once you choose your surgeon, the rest of recovery is up to you. Your job will be easier if you make the right choice of a surgeon.
The Next Step ...
You’ve now done a major portion of your homework—learning information about every aspect of augmentation so that you’ll have knowledge tools when you begin to consult surgeons. In the next chapters, we’ll locate qualified surgeons and help you with the steps in consultation and decision-making.
1 Tebbetts, J. B. Achieving a predictable 24-hour return to normal activities after breast augmentation, part 1: refining practices using motion and time study principles. Plast. Reconstr. Surg. 109: 293-305, 2002.
2 Tebbetts, J. B. Achieving a predictable 24-hour return to normal activities after breast augmentation, part II: patient preparation, refined surgical techniques and instrumentation. Plast. Reconstr. Surg. 109: 293-305, 2002.
3 Tebbetts J. B., and Adams, W. P. Five critical decisions in breast augmentation using five measurements in five minutes: the high five system. Plast. Reconstr. Surg. 116(7): 2005-2016, 2005.
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